Myocardial infarction and risk of suicide: another reason to develop and test ways to reduce distress in postmyocardial-infarction patients?

Epidemiological research over the past two decades has shown that psychosocial distress, whether assessed by measures of depression,1,2 hostility,3,4 social isolation,5 lower socioeconomic status,5 or job stress,6 is associated with increased risk of developing coronary heart disease and poorer prognosis once clinical disease is present. (See also7,8) We now learn, based on the report by Larsen and colleagues9 appearing in this issue of Circulation, that patients with psychosocial distress are not only at increased risk of dying from cardiovascular-related causes following a myocardial infarction (MI), they also seem to be at higher risk of dying by their own hand. In a sophisticated population-based case-control study that takes advantage of the availability of 5 nationwide longitudinal data registers in Denmark, Larsen et al9 were able to identify 19 857 persons who died by suicide from 1981 to 2006 and 190 058 controls matched for sex, day of birth, and calendar time. Compared with those with no history of psychiatric illness and who had not had an MI, persons with a history of psychiatric illness were 64 times more likely to commit suicide during the month after an MI. Even those with no history of psychiatric illness were more than 3 times more likely to commit suicide during the month after their MI. The increased suicide risk continued over more than 5 years of follow-up, albeit at lower levels than the first month after the MI, was more pronounced in younger patients, and was similar in men and women.